Professional paper - Review paper
Pregnancy in women with systemic lupus erythematosus

Anić, Felina; Novak, Srđan (2012)
Metadata
Language Croatian
Title (Croatian)Trudnoća u bolesnica sa sustavnim eritemskim lupusom
Title (English)Pregnancy in women with systemic lupus erythematosus
AuthorAnić, Felina
Novak, Srđan
Abstract (Croatian)
Sustavni eritemski lupus (SLE) kronična je upalna autoimuna bolest. Najčešće obolijevaju žene fertilne dobi, pa se međusoban utjecaj trudnoće i sustavnog eritemskog lupusa nameće kao značajan klinički i terapijski problem. Hormonski i imuni utjecaji koji se događaju u normalnoj trudnoći različito se reflektiraju na patogenetske mehanizme, tako da tijekom trudnoće može doći do pogoršanja osnovne bolesti, koje se prvenstveno manifestira u vidu kožnih i zglobnih manifestacija. U bolesnica sa SLE-om također je dokazana i veća učestalost opstetričkih komplikacija, kao što su spontani pobačaji, prijevremeni porodi, preeklampsija, porodi carskim rezom, kao i manja tjelesna masa novorođenčeta. Rizik od navedenih komplikacija je povećan, ako se radi o aktivnoj bolesti, ili je u bolesnica dokazana prisutnost antifosfolipidnih protutijela. Liječenje SLE-a u trudnoći predstavlja poseban izazov, te je trudnoću potrebno planirati u razdoblju kompletne remisije bolesti i to barem šest mjeseci od posljednje egzacerbacije bolesti. Bolesnice s blagim oblikom bolesti liječe se malom dozom prednizona. NSAR se može primjenjivati u trudnoći tijekom druge polovice prvog trimestra i tijekom drugog trimestra. Ako dođe do pogoršanja bolesti tijekom trudnoće, bolesnica se liječi većim dozama prednizona, uključujući pulsove glukokortikoida. Antimalarici (osobito hidroksiklorokin) mogu se primjenjivati u trudnoći radi korisnih učinaka na osnovnu bolest. U bolesnica koje imaju ponavljajuće pobačaje i pozitivna antifosfolipidna antitijela potrebno je primijeniti aspirin i/ili niskomolekularni heparin. Pažljivim planiranjem trudnoće, prvenstveno u fazi remisije bolesti, uz redovito praćenje i adekvatno liječenje, u bolesnica sa SLE-om moguće je izbjeći eventualne komplikacije povezane s trudnoćom.
Abstract (English)
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease. It primarily affects women in their reproductive years, making the issue of pregnancy important to doctors as a clinical and therapeutic problem. Due to the hormonal and immunological influence during pregnancy, an increase in disease activity can occur and manifest mostly as a musculoskeletal and cutaneous condition. Additionaly, women with SLE have a larger number of complicated pregnancies which can result in miscarriage, preterm birth, preeclampsia, cesearean section and low birth weight. Increased lupus activity, or presence of antiphospholipid antibodies significantly increases the risk for these comlications. Treatment of SLE in pregnancy represents a great challenge and the best prevention of lupus flare during pregnancy is to delay conception until the woman has had a period of quiescent disease for at least six months. Women who have mild SLE can be treated with low dose of prednisone. NSAIDs can be used during the latter part of the 1st trimester and during the 2nd trimester. If women develop lupus flare, they can be treated with higher doses of corticosteroids, including pulse steroid therapy. The antimalaric medications (especially hydroxychloroquine) may also be used during pregnancy to decrease the risk of SLE flare. Women with recurrent spontaneous abortion and antiphospholipid antibodies need to take aspirin and/or low molecular weight heparin. Careful planning, especially during remission, and appropriate treatment may be required to prevent possible complications that can happen during pregnancy.
Keywords (Croatian)aktivnost bolesti antifosfolipidni sindrom sustavni eritemski lupus trudnoća
Keywords (English)antiphospholipid sydrome lupus activity pregnancy systemic lupus erythematosus
Publication typeprofessional paper - review paper
Publication statuspublished
Peer reviewpeer review
Journal titleMedicina Fluminensis : Medicina Fluminensis
Numbering2012, Vol. 48, No. 1, pp 41-47
ISSN0025-7729
Datepublication: 01.03.2012.
Article URLhttp://hrcak.srce.hr/80229
Scientific fieldBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Internal Medicine
InstitutionUniversity of Rijeka, Faculty of Medicine
(Department of Internal Medicine)
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:149818